Abstract

Acute hemiparesis is a common cause of presentation to hospital. In the majority of cases the cause is acute stroke, which is ischaemic in 80% of cases. This article aims to provide the reader with a practical approach to the initial management of suspected stroke.The problem-based format highlights some of the specific questions raised in the 2009 curriculum for training in Acute Internal Medicine, with reference to recent guidance from the National Institute for Health and Clinical Excellence (NICE).
[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Bamford J, Sandercock P, Dennis M et al. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991; 337: 1521-6.
2. Meldrum D, Hardiman O, Pittocj SJ et al. The Oxfordshire community stroke project classification: correlation with imaging, associated complications and prediction of outcome in acute ischaemic stroke. Stroke Cerebrovasc Dis 2003: 12(1): 1-7.
3. Stone SP, Halligan PW, Greenwood RJ. The Incidence of Neglect Phenomena and Related Disorders in Patients with an Acute Right or Left Hemisphere Stroke. Age Ageing 1993; 2: 46-52.
4. American Heart Association & American Stroke Association Stroke Council. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals. Stroke 2009; 40(6): 2276-93.
5. Johnston SC, Rothwell PM, Nguyen-Huynh MN et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007; 369: 283–92.
6. Vroomen PCAJ, Buddingh MK, Luijckx GJ et al. The Incidence of Stroke Mimics Among Stroke Department Admissions in Relation to Age Group. J Stroke Cerebrovas Dis 2008; 17(6): 418-422.
7. vonKummer R, Bourquain H, Bozzao S et al. Early prediction of Irreversible brain damage after ischaemic stroke at CT. Radiol 2001; 219: 95-100.
8. NICE Clinical Guideline 68. Stroke: Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA) http://www.nice.org.uk/CG68
9. NICE Technology Appraisal 210: clopidogrel and modified-release dipyridamole for prevention of occlusive vascular events. http://guidance.nice.org.uk/TA210/
10. The National Institute of Neurological Disorders and Stroke rt-PA Stroke study group. NEJM 1995; 333(24): 1581-7.
11. Hacke W, Kaste M, Bluhmki E et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischaemic stroke. NEJM 2008; 359(13): 1317-29.
12. Rha JH, Saver JL. The Impact of Recanalization on Ischemic Stroke Outcome: A Meta-Analysis. Stroke 2007. 38: 967-973.
13. Hacke W, Schwab S, Horn M et al. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 1996; 53(4): 309-15.
14. Vahedi K, Hofmeijer J, Juettler E et al1. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007; 6(3): 215-22.